Maternal-Fetal Medicine Specialist to Lead One of Busiest Obstetrics Practices in Ohio

Cleveland Clinic has appointed Edward Chien, MD, MBA, as its new Chair of the Department of Obstetrics and Gynecology. Dr. Chien earned his Doctor of Medicine at the University of Illinois at Chicago. After finishing his residency at the University of Michigan Medical Center he went on to complete his fellowship in Maternal-Fetal Medicine at the University of Chicago. Dr. Chien also holds a Masters of Business Administration from the George Washington University School of Business.

Dr. Chien is Professor of Reproductive Biology at Case Western Reserve University. Prior to joining Cleveland Clinic, Dr. Chien was Director of the Division of Maternal-Fetal Medicine at MetroHealth Medical Center and served as Program Director for the Maternal-Fetal Medicine fellowship. In addition, Dr. Chien served as the Maternal-Fetal Medicine Fellowship Director at Brown University and at the University of Vermont. In his new role, Dr. Chien will lead one of the busiest obstetrics practices in Ohio, accounting for approximately 10% of annual births in the state and 60% of births in Cuyahoga County.

Recently, Consult QD had the opportunity to get to know this nationally recognized Maternal-Fetal Medicine specialist, and discuss his vision for the department.

Consult QD: What are your research interests?

Dr. Chien: I’ve pursued a combination of bench and clinical research. From the bench, I studied cervical biomechanics, looking at the implications of cervical remodeling on pregnancy and labor. On the clinical side, together with collaborators, I participated in the Eunice Kennedy Shriver National Institute of Child Health and Development’s (NICHD) National Fetal Growth Study, using ultrasound to determine a standard for normal fetal growth in the U.S. population. Until the study was published in 2015, there were a number of different population-based cross-sectional studies of fetal growth, but no national standard. We recruited low-risk individuals and followed them through pregnancy with ultrasound. We did identify variation among individuals in our study population based on race and ethnicity, pointing to the value of racial/ethnic-specific standards to improve precision in fetal growth evaluation.

I was also part of the NICHD Maternal-Fetal Medicine Unit (MFMU) Network. Recently, one of our studies that received a lot of press was A Randomized tRial of Induction Versus Expectant management (ARRIVE). In ARRIVE, we examined the effect on neonatal outcomes of induction of labor at 39 weeks in first pregnancies versus expectant management. We found in this population, induction did not result in a significant difference in perinatal adverse outcomes, though it did result in fewer cesarean deliveries.

Consult QD: What do you consider to be the most exciting areas of opportunity in Ob/Gyn in the next 5-10 years?

Dr. Chien: Most of obstetric care has been focused on prenatal care and delivery. There’s been very little focus on the postpartum period although a large percentage of the morbidity actually occurs during that period of time. In the next several years, I expect our focus will be on safety and reducing pregnancy-associated morbidity and mortality in the postpartum period. With the use of guidelines and standards, I think we can actually improve care in the general population, reducing cesarean sections and improving outcomes after delivery.

I also expect that more research will be done as to what constitutes optimal care during labor and the postpartum period. For example, how do we manage hypertension in patients who’ve had hypertension-related pregnancy disorders to reduce both complications and readmission rates? How do we reduce the risk of thrombosis? What are the best practices for postpartum contraception?

Consult QD: What is your vision for Ob/Gyn care at Cleveland Clinic?

Dr. Chien: I’d like to see Cleveland Clinic recognized for its leadership in obstetrics care. We are already ranked among the top adult gynecology hospitals by U.S. News & World Report. Down the road, I’d like Cleveland Clinic to also be known for setting the standards across the country for safe, high-quality obstetrics care.

Under Dr. Ridgeway’s leadership, the Ob/Gyn & Women’s Health Institute has begun working toward a multidisciplinary and collaborative approach to prenatal care and delivery, starting with developing guidelines for prevention and the management of obstetric emergencies. Additionally, I’d like to see Maternal-Fetal Medicine shift its focus a bit more toward the maternal side.

Consult QD: What would you say are current challenges in healthcare?

Dr. Chien: One of the challenges many physicians are having is navigating the variations in approved medications among the various insurance companies and the processes they use to control cost. The large variability can often lead to delays in initiating therapy. The necessary information isn’t generally readily available. Prior authorizations also take a lot of time away from patient care.

An additional challenge is projecting future demand for providers, and determining how best to meet those needs. Are we going to meet those needs with physicians? Or are we going to meet those needs with advanced practice providers (e.g., nurse practitioners, physician assistants and midwives)? We clearly need to build capacity going forward, and based on some of the conversations I’ve had so far, our patients might be better served with advanced practice providers for routine annual exams. Over the long term, it may be a space issue as well, as we may not have the space to accommodate the providers needed to deliver care. The good news is that Cleveland Clinic is already moving forward with innovative programs to meet these challenges such as evaluating virtual care and studying ways to improve population health.